{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,11]],"date-time":"2026-09-11T10:31:35Z","timestamp":1789122695283,"version":"build-2803163510"},"reference-count":106,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2025,5,28]],"date-time":"2025-05-28T00:00:00Z","timestamp":1748390400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["aao-hnsfjournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Otolaryngol.--head neck surg."],"published-print":{"date-parts":[[2025,6]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Objective<\/jats:title><jats:p>The purpose of this specialty\u2010specific clinical practice guideline is to identify quality improvement opportunities and provide clinicians with trustworthy, evidence\u2010based recommendations for the surgical management of chronic rhinosinusitis in adults. The target audience includes otolaryngologist\u2010head and neck surgeons who manage adults with chronic rhinosinusitis, including candidacy and performance of endoscopic sinus surgery.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This executive summary describes the guideline developed using the 55\u2010page protocol published as the American Academy of Otolaryngology\u2013Head and Neck Surgery Foundation's <jats:italic>Clinical Practice Guideline Development Manual<\/jats:italic> (3rd edition), which summarizes the methodology for assessments of current data, topic prioritization, development of key action statements (KASs), application of value judgments, and related procedures. The guideline group represented otolaryngologists, rhinologists, advanced practice nursing and physician assistants, and consumers who represented participating national professional organizations.<\/jats:p><\/jats:sec><jats:sec><jats:title>Action Statements<\/jats:title><jats:p>The Guideline Development Group made <jats:italic>strong recommendations<\/jats:italic> for the following KASs: Before considering surgery, the surgeon should verify an existing diagnosis of chronic rhinosinusitis to ensure established diagnostic criteria (signs and symptoms) from clinical practice guidelines are met, and the surgeon should assess candidacy for sinus surgery based on symptoms, disease characteristics, quality of life, and prior medical or surgical therapy (KASs 1A and 1B). The surgeon or their designee should <jats:italic>not<\/jats:italic> prescribe antibacterial therapy to an adult with chronic rhinosinusitis if significant or persistent purulent nasal discharge (anterior, posterior, or both) is absent on examination (KAS 3).<\/jats:p><jats:p>The Guideline Development Group made <jats:italic>recommendations<\/jats:italic> for the following KASs: The surgeon should not endorse or require a predefined, one\u2010size\u2010fits\u2010all regimen or duration of medical therapy (eg, antibiotics, steroids, antihistamines) as a prerequisite to sinus surgery for an adult with chronic rhinosinusitis (KAS 2). The surgeon should identify patients with chronic rhinosinusitis that would benefit most from surgery and are least likely to benefit from continued medical therapy alone, such as those with chronic rhinosinusitis subtypes that include, but are not limited to, chronic rhinosinusitis with polyps, polyps with bony erosion, eosinophilic mucin, or fungal balls (KAS 4). The surgeon or their designee should counsel patients before sinus surgery to establish realistic expectations, including the potential for chronicity or relapse, and the likelihood of long\u2010term medical management, taking into account their chronic rhinosinusitis subtype (KAS 5). The surgeon should offer sinus surgery to an adult with chronic rhinosinusitis when the anticipated benefits exceed that of nonsurgical management alone, there is clarity regarding the anticipated outcomes, and the patient understands the expectation for long\u2010term disease management following surgery (KAS 6). For an adult who is a candidate for sinus surgery, the surgeon or their designee should obtain a computed tomography (CT) scan with a fine\u2010cut protocol, if not already available, to examine the paranasal sinuses for surgical planning (KAS 7). The surgeon should not plan the extent of sinus surgery (eg, which specific sinuses to operate on) solely based on arbitrary criteria regarding a minimal level of mucosal thickening, sinus opacification, or outflow obstruction on a CT scan (KAS 8). The surgeon or their designee should educate an adult with chronic rhinosinusitis who is scheduled for sinus surgery regarding anticipated postoperative care, specifically pain control, debridement, medical management, activity restrictions, return to work, duration and frequency of follow\u2010up visits, and the potential for recurrent disease or revision surgery (KAS 9). When the sinus involves polyps, osteitis, bony erosion, or fungal disease in an adult with chronic rhinosinusitis who is scheduled for sinus surgery, the surgeon should perform sinus surgery that includes full exposure of the sinus cavity (lumen) and removal of diseased tissue, not just balloon or manual ostial dilation, or refer the patient to a surgeon who can perform this extent of surgery (KAS 10). The surgeon or their designee should routinely follow up to assess and document outcomes of sinus surgery for chronic rhinosinusitis, between 3 and 12 months after the procedure, through history (symptom relief, quality of life, complications, adherence to therapy, need for rescue medications, and ongoing care) and nasal endoscopy (KAS 11). There were no recommendations that were considered <jats:italic>options<\/jats:italic> from the Guideline Development Group.<\/jats:p><\/jats:sec>","DOI":"10.1002\/ohn.1286","type":"journal-article","created":{"date-parts":[[2025,5,28]],"date-time":"2025-05-28T23:54:37Z","timestamp":1748476477000},"page":"1807-1832","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Executive Summary of the Clinical Practice Guideline on the Surgical Management of Chronic Rhinosinusitis"],"prefix":"10.1002","volume":"172","author":[{"given":"Jennifer J.","family":"Shin","sequence":"first","affiliation":[{"name":"Division of Otolaryngology Harvard Medical School Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Meghan","family":"Wilson","sequence":"additional","affiliation":[{"name":"Associated Otolaryngologists of Pennsylvania Hershey Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Margo","family":"McKenna","sequence":"additional","affiliation":[{"name":"University Otolaryngology Associates\/University of Rochester Rochester New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Richard","family":"Rosenfeld","sequence":"additional","affiliation":[{"name":"SUNY Downstate Health Sciences University Brooklyn New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kathryn","family":"Ammon","sequence":"additional","affiliation":[{"name":"Children's Hospital of Philadelphia Philadelphia Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dana","family":"Crosby","sequence":"additional","affiliation":[{"name":"Southern Illinois University School of Medicine Springfield Illinois USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jonathan M.","family":"Fuchs","sequence":"additional","affiliation":[{"name":"The Kidder Street Consulting Group Huntington Beach California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jason Blakeley","family":"Hensler","sequence":"additional","affiliation":[{"name":"South Texas Sinus Institute McAllen Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elisa A.","family":"Illing","sequence":"additional","affiliation":[{"name":"Indiana University Indianapolis Indiana USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kent","family":"Lam","sequence":"additional","affiliation":[{"name":"Eastern Virginia Medical School Norfolk Virginia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Corinna","family":"Levine","sequence":"additional","affiliation":[{"name":"University of Miami Miller School Miami Florida USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Steven T.","family":"Kmucha","sequence":"additional","affiliation":[{"name":"SIGMA ENT Orinda California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Edward D.","family":"McCoul","sequence":"additional","affiliation":[{"name":"Ochsner Clinic Foundation New Orleans Louisiana USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jessa","family":"Miller","sequence":"additional","affiliation":[{"name":"UCLA Medical Center Los Angeles California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kenneth","family":"Rodriguez","sequence":"additional","affiliation":[{"name":"University Hospitals Cleveland Medical Center Cleveland Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicholas R.","family":"Rowan","sequence":"additional","affiliation":[{"name":"Johns Hopkins University School of Medicine Baltimore Maryland USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ahmad R.","family":"Sedaghat","sequence":"additional","affiliation":[{"name":"UC Health\/University of Cincinnati College of Medicine Cincinnati Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bruce K.","family":"Tan","sequence":"additional","affiliation":[{"name":"Northwestern University Chicago Illinois USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emma","family":"Roy","sequence":"additional","affiliation":[{"name":"American Academy of Otolaryngology\u2013Head and Neck Surgery Foundation Alexandria Virginia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nui","family":"Dhepyasuwan","sequence":"additional","affiliation":[{"name":"American Academy of Otolaryngology\u2013Head and Neck Surgery Foundation Alexandria Virginia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,5,28]]},"reference":[{"key":"e_1_2_11_2_1","unstructured":"CDC. 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